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Croci E, Born P, Eckers F, Nüesch C, Baumgartner D, Müller AM, Mündermann A. Test-retest reliability of isometric shoulder muscle strength during abduction and rotation tasks measured using the Biodex dynamometer. J Shoulder Elbow Surg 2023; 32:2008-2016. [PMID: 37178965 DOI: 10.1016/j.jse.2023.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/13/2023] [Accepted: 03/22/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND The Constant score (CS) is often used clinically to assess shoulder function and includes a muscle strength assessment only for abduction. The aim of this study was to evaluate the test-retest reliability of isometric shoulder muscle strength during various positions of abduction and rotation with the Biodex dynamometer and to determine their correlation with the strength assessment of the CS. METHODS Ten young healthy subjects participated in this study. Isometric shoulder muscle strength was measured during 3 repetitions for abduction at 10° and 30° abduction in the scapular plane (with extended elbow and hand in neutral position) and for internal and external rotation (with the arm at 15° abduction in the scapular plane and elbow flexed at 90°). Muscle strength tests with the Biodex dynamometer were measured in 2 different sessions. The CS was acquired only in the first session. Intraclass correlation coefficients (ICCs) with 95% confidence interval, limits of agreement, and paired t tests for repeated tests of each abduction and rotation task were calculated. Pearson's correlation between the strength parameter of the CS and isometric muscle strength was investigated. RESULTS Muscle strength did not differ between tests (P > .05) with good to very good reliabilities for abduction at 10° and 30°, external rotation and internal rotation (ICC >0.7 for all). A moderate correlation of the strength parameter of the CS with all isometric shoulder strength parameters was observed (r > 0.5 for all). CONCLUSION Shoulder muscle strength for abduction and rotation measured with the Biodex dynamometer are reproducible and correlate with the strength assessment of the CS. Therefore, these isometric muscle strength tests can be further employed to investigate the effect of different shoulder joint pathology on muscle strength. These measurements consider a more comprehensive functionality of the rotator cuff than the single strength evaluation in abduction within the CS as both abduction and rotation are assessed. Potentially, this would allow for a more precise differentiation between the various outcomes of rotator cuff tears.
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Affiliation(s)
- Eleonora Croci
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland.
| | - Patrik Born
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Franziska Eckers
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Corina Nüesch
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland; Department of Spine Surgery, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Daniel Baumgartner
- IMES Institute of Mechanical Systems, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Andreas Marc Müller
- Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Annegret Mündermann
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland; Department of Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland; Department of Spine Surgery, University Hospital Basel, Basel, Switzerland; Department of Clinical Research, University of Basel, Basel, Switzerland
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van der Woude DR, Ruyten T, Bartels B. Reliability of Muscle Strength and Muscle Power Assessments Using Isokinetic Dynamometry in Neuromuscular Diseases: A Systematic Review. Phys Ther 2022; 102:6650967. [PMID: 35899532 PMCID: PMC10071497 DOI: 10.1093/ptj/pzac099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 04/22/2022] [Accepted: 07/27/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The purpose of this study was to critically appraise and summarize the evidence for reliability of muscle strength and muscle power assessment in patients with neuromuscular diseases (NMDs) using isokinetic dynamometry. METHODS PubMed, CINAHL, and Embase electronic databases were searched from inception to March 8, 2022. Studies designed to evaluate reliability of muscle strength and power measurements using isokinetic dynamometry were included in this review. First, the methodological quality of the studies was assessed according to the Consensus-Based Standards for the Selection of Health Measurement Instruments guidelines. Next, the quality of measurement properties was determined. Finally, the methodological quality and quality of measurement properties of the studies were combined to obtain a best-evidence synthesis. RESULTS A best-evidence synthesis of reliability was performed in 11 studies including postpoliomyelitis syndrome (n = 5), hereditary motor and sensory neuropathy (n = 2), motor neuron diseases (n = 1), myotonic dystrophy (n = 1), and groups of pooled NMDs (n = 2). A best-evidence synthesis on measurement error could not be performed. Quality of evidence on reliability ranged from high in postpoliomyelitis syndrome to very low in hereditary motor and sensory neuropathy, motor neuron diseases, and groups of pooled NMDs. The most frequently used outcome measure was peak torque, which was reliable in all populations (intraclass correlation coefficient >0.7). CONCLUSION The quality of evidence for reliability of isokinetic dynamometry was found to vary substantially among different NMDs. High quality of evidence has been obtained only in patients with postpoliomyelitis syndrome. Further research is needed in the majority of known NMDs to determine reliability and validity of isokinetic dynamometry. IMPACT The ability of isokinetic dynamometers to capture clinically relevant changes in muscle strength and muscle power in NMDs remains unclear. Isokinetic dynamometry results in NMDs should be interpreted with caution.
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Affiliation(s)
- Danny R van der Woude
- Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Thijs Ruyten
- Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Bart Bartels
- Child Development and Exercise Center, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, the Netherlands
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Chia DSY, Doi K, Hattori Y, Sakamoto S. Elbow flexion strength and contractile activity after partial ulnar nerve or intercostal nerve transfers for brachial plexus injuries. J Hand Surg Eur Vol 2020; 45:818-826. [PMID: 32380918 DOI: 10.1177/1753193420922184] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We compared the outcomes of 23 partial ulnar nerve and 15 intercostal nerve transfers for elbow flexion reconstruction in patients with C56 or C567 brachial plexus injuries using manual muscle power, dynamometric measurements of elbow flexion strength and electromyography. The range of elbow flexion and muscle strength recovery to Grade 3 or 4 were comparable between the two groups. The patients with C567 injuries had significantly stronger eccentric contraction after the partial ulnar nerve transfer than after the intercostal nerve transfer (p < 0.05). Electromyography of individual muscles demonstrated that the patients with partial ulnar nerve transfers were unable to voluntarily isolate biceps contraction and recruited forearm flexors and extensors. The patients after partial ulnar nerve transfer had significantly more activity of the forearm muscles during concentric elbow flexion than after intercostal nerve transfers (p < 0.05). We conclude that partial ulnar nerve transfers were superior to intercostal nerve transfers when assessed quantitatively with the dynamometer to evaluate elbow flexion, although simultaneous recruitment of forearm muscles may have contributed to the increased elbow flexion strength in the patients with the partial ulnar nerve transfer.Level of evidence: III.
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Affiliation(s)
- Dawn Sinn Yii Chia
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Ogori, Japan
| | - Kazuteru Doi
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Ogori, Japan
| | - Yasunori Hattori
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Ogori, Japan
| | - Sotetsu Sakamoto
- Department of Orthopedic Surgery, Ogori Daiichi General Hospital, Ogori, Japan
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Nuzzo JL, Taylor JL, Gandevia SC. CORP: Measurement of upper and lower limb muscle strength and voluntary activation. J Appl Physiol (1985) 2019; 126:513-543. [DOI: 10.1152/japplphysiol.00569.2018] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Muscle strength, the maximal force-generating capacity of a muscle or group of muscles, is regularly assessed in physiological experiments and clinical trials. An understanding of the expected variation in strength and the factors that contribute to this variation is important when designing experiments, describing methodologies, interpreting results, and attempting to replicate methods of others and reproduce their findings. In this review (Cores of Reproducibility in Physiology), we report on the intra- and inter-rater reliability of tests of upper and lower limb muscle strength and voluntary activation in humans. Isometric, isokinetic, and isoinertial strength exhibit good intra-rater reliability in most samples (correlation coefficients ≥0.90). However, some tests of isoinertial strength exhibit systematic bias that is not resolved by familiarization. With the exception of grip strength, few attempts have been made to examine inter-rater reliability of tests of muscle strength. The acute factors most likely to affect muscle strength and serve as a source of its variation from trial-to-trial or day-to-day include attentional focus, breathing technique, remote muscle contractions, rest periods, temperature (core, muscle), time of day, visual feedback, body and limb posture, body stabilization, acute caffeine consumption, dehydration, pain, fatigue from preceding exercise, and static stretching >60 s. Voluntary activation, the nervous system’s ability to drive a muscle to create its maximal force, exhibits good intra-rater reliability when examined with twitch interpolation (correlation coefficients >0.80). However, inter-rater reliability has not been formally examined. The methodological factors most likely to influence voluntary activation are myograph compliance and sensitivity; stimulation location, intensity, and inadvertent stimulation of antagonists; joint angle (muscle length); and the resting twitch.
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Affiliation(s)
- James L. Nuzzo
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Janet L. Taylor
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- School of Medical Sciences, University of New South Wales, Sydney, Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, Western Australia, Australia
| | - Simon C. Gandevia
- Neuroscience Research Australia, Randwick, New South Wales, Australia
- Prince of Wales Hospital Clinical School, University of New South Wales, Sydney, Australia
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Ding Q, Patten C. External biomechanical constraints impair maximal voluntary grip force stability post-stroke. Clin Biomech (Bristol, Avon) 2018; 57:26-34. [PMID: 29894857 DOI: 10.1016/j.clinbiomech.2018.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 04/23/2018] [Accepted: 06/04/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Grip strength is frequently measured as a global indicator of motor function. In clinical populations, such as hemiparesis post-stroke, grip strength is associated with upper-extremity motor impairment, function, and ability to execute activities of daily living. However, biomechanical configuration of the distal arm and hand may influence the magnitude and stability of maximal voluntary grip force and varies across studies. The influence of distal arm/hand biomechanical configuration on grip force remains unclear. Here we investigated how biomechanical configuration of the distal arm/hand influence the magnitude and trial-to-trial variability of maximal grip force performed in similar positions with variations in external constraint. METHODS We studied three groups of 20 individuals: healthy young, healthy older, and individuals post-stroke. We tested maximal voluntary grip force in 4 conditions: 1: self-determined/"free"; 2: standard; 3: fixed arm-rest; 4: gripper fixed to arm-rest, using an instrumented grip dynamometer in both dominant/non-dominant and non-paretic/paretic hands. FINDINGS Regardless of hand or group, maximal voluntary grip force was highest when the distal limb was most constrained (i.e., Condition 4), followed by the least constrained (i.e., Condition 1) (Cohen's f = 0.52, P's < 0.001). Coefficient of variation among three trials was greater in the paretic hand compared with healthy individuals, particularly in more (Conditions 3 and 4) compared to less (Conditions 1 and 2) constrained conditions (Cohen's f = 0.29, P's < 0.05). INTERPRETATION These findings have important implications for design of rehabilitation interventions and devices. Particularly in individuals post-stroke, external biomechanical constraints increase maximal voluntary grip force variability while fewer biomechanical constraints yield more stable performance.
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Affiliation(s)
- Qian Ding
- Neural Control of Movement Lab, Malcolm Randall VA Medical Center (151A), Gainesville, FL 32608, USA; Rehabilitation Sciences Doctoral Program, Department of Physical Therapy, University of Florida, Gainesville, FL 32608, USA
| | - Carolynn Patten
- Biomechanics and Neural Control of Movement Lab, University of California, Davis School of Medicine, Northern California VA Health Care System, Sacramento, CA 95817, USA.
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Chen CY, McGee CW, Rich TL, Prudente CN, Gillick BT. Reference values of intrinsic muscle strength of the hand of adolescents and young adults. J Hand Ther 2018; 31:348-356. [PMID: 28807597 PMCID: PMC5955806 DOI: 10.1016/j.jht.2017.05.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 04/28/2017] [Accepted: 05/24/2017] [Indexed: 02/09/2023]
Abstract
STUDY DESIGN A cross-sectional clinical measurement study. INTRODUCTION Measuring intrinsic hand muscle strength helps evaluate hand function or therapeutic outcomes. However, there are no established normative values in adolescents and young adults between 13 and 20 years of age. PURPOSE OF THE STUDY To measure hand intrinsic muscle strength and identify associated factors that may influence such in adolescents and young adults through use of the Rotterdam intrinsic hand myometer. METHODS A total of 131 participants (male: 63; female: 68) between 13 and 20 years of age completed the strength measurements of abductor pollicis brevis, first dorsal interosseus (FDI), deep head of FDI and lumbrical of second digit, flexor pollicis brevis (FPB), and abductor digiti minimi. Two trials of the measurements of each muscle were averaged for analyses. Self-reported demographic data were used to examine the influences of age, sex, and body mass index (BMI) on intrinsic hand muscle strength. RESULTS Normative values of intrinsic hand muscle strength were presented by age groups (13, 14, 15-16, 17-18, 19-20 year olds) for each sex category (male, female). A main effect of sex, but not age, on all the muscles on both the dominant (FPB: P = .02, others: P < .001) and non-dominant (FDI: P = .005, FPB: P = .01, others: P < .001) sides was found. A significant effect of BMI was found on dominant (P = .009) and non-dominant abductor pollicis brevis (P = .002). In addition, FDI (P = .005) and FPB (P = .002) were stronger on the dominant side than the non-dominant side. DISCUSSION Intrinsic hand muscle strength may be influenced by different factors including sex, BMI, and hand dominance. A larger sample is needed to rigorously investigate the influence of age on intrinsic strength in male and female adolescents and young adults. CONCLUSION The results provide reference values and suggest factors to be considered when evaluating hand function and therapeutic outcomes in both clinical and research settings. Further study is recommended. LEVEL OF EVIDENCE VI.
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Affiliation(s)
- Chao-Ying Chen
- Department of Physical Medicine and Rehabilitation, Medical School, University of Minnesota, Minneapolis, MN, USA,Corresponding author. Department of Rehabilitation Medicine, Medical School, University of Minnesota, MMC 388, 420 Delaware Street SE, Minneapolis, MN 55455, USA. Tel.: 612-626-3121; fax: 612-625-4274., (C.-Y. Chen)
| | - Corey W. McGee
- Department of Rehabilitation Medicine Programs in Rehabilitation Science, University of Minnesota, Minneapolis, MN, USA
| | - Tonya L. Rich
- Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Cecília N. Prudente
- Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, USA
| | - Bernadette T. Gillick
- Department of Rehabilitation Medicine, Medical School, University of Minnesota, Minneapolis, MN, USA
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Dvir Z, Oh JS, Kang MH. Response to "Reproducibility of isometric shoulder protraction and retraction strength measurements in normal subjects and individuals with winged scapula; methodologic and statistical issue to avoid misinterpretation". J Shoulder Elbow Surg 2017; 26:e109. [PMID: 28325275 DOI: 10.1016/j.jse.2017.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 02/02/2017] [Indexed: 02/01/2023]
Affiliation(s)
- Zeevi Dvir
- Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, 69978 Israel.
| | - Jae-Seop Oh
- Department of Physical Therapy, College of Biomedical Science and Engineering, Inje University, Gimhae, Republic of Korea
| | - Min-Hyeok Kang
- Department of Physical Therapy, Graduate School, Inje University, Gimhae, Republic of Korea
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Oh JS, Kang MH, Dvir Z. Reproducibility of isometric shoulder protraction and retraction strength measurements in normal subjects and individuals with winged scapula. J Shoulder Elbow Surg 2016; 25:1816-1823. [PMID: 27262411 DOI: 10.1016/j.jse.2016.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 02/25/2016] [Accepted: 03/13/2016] [Indexed: 02/01/2023]
Abstract
BACKGROUND The strength of the shoulder protractors and retractors may be compromised in individuals with winged scapula (IwWS). However, no standard approach to measuring the strength of these muscles has been described. The aim of this study was to study the intra-rater and inter-rater reproducibility of a fixed-base isometric dynamometer and to describe cutoff scores for clinically meaningful change for protraction and retraction isometric strength. METHOD Twice during a week, 20 normal subjects and 20 IwWS were tested by 2 independent raters. RESULTS IwWS were significantly weaker (P < .001) than control subjects in their protraction and retraction isometric strength. Excellent intra-rater and inter-rater correlations were obtained in most combinations, leading to low cutoff scores for meaningful change expressed in terms of the smallest real difference. CONCLUSION When it is properly used, the technique described in this paper is recommended as an effective clinical tool for the quantitative assessment of protraction and retraction isometric strength, both for status determination and for monitoring of change in IwWS during and after rehabilitation.
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Affiliation(s)
- Jae-Seop Oh
- Department of Physical Therapy, College of Biomedical Science and Engineering, Inje University, Gimhae, Republic of Korea
| | - Min-Hyeok Kang
- Department of Physical Therapy, Graduate School, Inje University, Gimhae, Republic of Korea
| | - Zeevi Dvir
- Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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Muscle Weakness and Perceived Disability of Upper Limbs in Persons With Late Effects of Polio. PM R 2016; 8:825-32. [DOI: 10.1016/j.pmrj.2016.02.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 01/13/2016] [Accepted: 02/06/2016] [Indexed: 11/19/2022]
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